Pedicle Morphology Analysis in Adolescents with Lenke Type 5 Idiopathic Scoliosis in Thai Population

Tinnakorn Pluemvitayaporn; Tassana Kaewmano; Sombat Kunakornsawat; Suttinont Surapuchong; Warot Ratanakoosakul; Kitjapat Tiracharnvut; Pritsanai Pruttikul; Chaiwat Piyasakulkaew; Piyabuth Kittithamvongs

doi:10.1055/s-0044-1800812

Asian Journal of Neurosurgery, Table of Contents

CC BY-NC-ND 4.0 · Asian J Neurosurg 2025; 20(01): 132-137
DOI: 10.1055/s-0044-1800812

Original Article

Pedicle Morphology Analysis in Adolescents with Lenke Type 5 Idiopathic Scoliosis in Thai Population

Tinnakorn Pluemvitayaporn

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Tassana Kaewmano

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Sombat Kunakornsawat

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Suttinont Surapuchong

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Warot Ratanakoosakul

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Kitjapat Tiracharnvut

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Pritsanai Pruttikul

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Chaiwat Piyasakulkaew

¹Spine Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

,

Piyabuth Kittithamvongs

²Research Unit, Department of Orthopaedic Surgery, Institute of Orthopedics, Lerdsin Hospital, College of Medicine, Rangsit University, Bangkok, Thailand

› Author Affiliations

Abstract

Background The surgical management of adolescent idiopathic scoliosis (AIS) often incorporates the utilization of pedicle screws, which are three-column construct devices. A comprehensive understanding of the pedicle morphology is essential for determining the appropriate pedicle screw diameter. While previous studies have examined pedicle morphology in Lenke type 1 AIS, there is a scarcity of information about the pedicle morphology in Lenke type 5 AIS, especially in the Thai population.

Objective The aim of this study is to analyze the morphology of the thoracolumbar pedicle, specifically the pedicle width and trajectory length on both the concave and convex sides within a sample of the Thai population diagnosed with Lenke type 5 AIS.

Materials and Methods In this study, we used computed tomography (CT) measurements to examine the thoracolumbar pedicle morphology in Lenke type 5 AIS patients in the Thai population. We also analyzed the pedicle width and trajectory length on both concave and convex sides in 112 AIS patients with Lenke type 5 curvature.

Results A total of 3,808 pedicles from 112 consecutive AIS patients of Lenke type 5 were enrolled in the study. It was observed that the transverse pedicle width was notably smaller on the concave side compared with the convex side in the apical region of the thoracolumbar spine (T12 to L2). Additionally, the pedicle width of T3 was also found to be significantly smaller on the concave side. Moreover, it was noted that the pedicle trajectory length is significantly longer on the concave side, indicating that the concave side in the apical region may have the capacity to accommodate a slightly longer pedicle screw at T3, T6, L2, L3, and L4.

Conclusion Our analysis of measurements indicates that the thoracolumbar pedicle morphology in Lenke type 5 AIS among the Thai population typically shows smaller widths and longer trajectory lengths on the concave side. This information enhances our understanding of the appropriate selection of pedicle screw diameter and length for treating Lenke type 5 AIS in the Thai population.

Keywords

pedicle - pedicle morphology - adolescent idiopathic scoliosis - Lenke type 5

Full Text

References

References
1 Roach JW. Adolescent idiopathic scoliosis. Orthop Clin North Am 1999; 30 (03) 353-365 , vii–viii
2 Liljenqvist U, Hackenberg L. Morphometric analysis of thoracic and lumbar vertebrae in idiopathic scoliosis. Stud Health Technol Inform 2002; 88: 382-386
3 Li G, Lv G, Passias P. et al. Complications associated with thoracic pedicle screws in spinal deformity. Eur Spine J 2010; 19 (09) 1576-1584
4 Suk SI, Kim WJ, Lee SM, Kim JH, Chung ER. Thoracic pedicle screw fixation in spinal deformities: are they really safe?. Spine 2001; 26 (18) 2049-2057
5 O'Brien MF, Lenke LG, Mardjetko S. et al. Pedicle morphology in thoracic adolescent idiopathic scoliosis: is pedicle fixation an anatomically viable technique?. Spine 2000; 25 (18) 2285-2293
6 Hu X, Siemionow KB, Lieberman IH. Thoracic and lumbar vertebrae morphology in Lenke type 1 female adolescent idiopathic scoliosis patients. Int J Spine Surg 2014; 8: 30
7 Bunmaprasert T, Roobsoong A, Pongmanee S, Khunsree S, Laowatthanaphong S. Safety entry point, size and direction for placement of thoracic pedicle screw: a cadaveric study. J Med Assoc Thai 2014; 97 (12) 1344-1351
8 Lenke LG, Betz RR, Harms J. et al. Adolescent idiopathic scoliosis: a new classification to determine extent of spinal arthrodesis. J Bone Joint Surg Am 2001; 83 (08) 1169-1181
9 Chan CYW, Kwan MK. Safety of pedicle screws in adolescent idiopathic scoliosis surgery. Asian Spine J 2017; 11 (06) 998-1007
10 Zindrick MR, Wiltse LL, Widell EH. et al. A biomechanical study of intrapeduncular screw fixation in the lumbosacral spine. Clin Orthop Relat Res 1986; 1 (203) 99-112
11 Deng Y, Zhou Y, Lu G. et al; South Univ. Complication of thoracic pedicle screw fixation in spinal deformities. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2009; 34 (08) 820-824
12 Kwan MK, Chiu CK, Gani SMA, Wei CCY. Accuracy and safety of pedicle screw placement in adolescent idiopathic scoliosis patients: a review of 2020 screws using computed tomography assessment. Spine 2017; 42 (05) 326-335
13 Ketenci İE, Yanik HS, Erdem Ş. Pedicle morphometry of thoracic and lumbar vertebrae in adolescent idiopathic scoliosis. Medeniyet Med J 2018; 33: 69-74
14 Gao B, Gao W, Chen C. et al. What is the difference in morphologic features of the thoracic pedicle between patients with adolescent idiopathic scoliosis and healthy subjects? A CT-based case-control study. Clin Orthop Relat Res 2017; 475 (11) 2765-2774
15 Zhang W, Takigawa T, Wu Y, Sugimoto Y, Tanaka M, Ozaki T. Accuracy of pedicle screw insertion in posterior scoliosis surgery: a comparison between intraoperative navigation and preoperative navigation techniques. Eur Spine J 2017; 26 (06) 1756-1764
16 Abul-Kasim K, Ohlin A. Patients with adolescent idiopathic scoliosis of Lenke type-1 curve exhibit specific pedicle width pattern. Eur Spine J 2012; 21 (01) 57-63
17 Upendra B, Meena D, Kandwal P, Ahmed A, Chowdhury B, Jayaswal A. Pedicle morphometry in patients with adolescent idiopathic scoliosis. Indian J Orthop 2010; 44 (02) 169-176
18 Krag MH, Weaver DL, Beynnon BD, Haugh LD. Morphometry of the thoracic and lumbar spine related to transpedicular screw placement for surgical spinal fixation. Spine 1988; 13 (01) 27-32
19 Liljenqvist UR, Halm HF, Link TM. Pedicle screw instrumentation of the thoracic spine in idiopathic scoliosis. Spine (Phila Pa 1976) 1997; 22 (19) 2239-2245
20 Kotwicki T, Napiontek M. Intravertebral deformation in idiopathic scoliosis: a transverse plane computer tomographic study. J Pediatr Orthop 2008; 28 (02) 225-229